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Ketamine: A depression drug that researchers have called ‘the most important discovery in half a century’ just got a big lift
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2018-05-07 17:10:55
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Ketamine: A depression drug that researchers have called ‘the most important discovery in half a century’ just got a big lift

Ketamine, which has been called “the most important discovery in half a century,” just got a step closer to becoming the first new depression drug in 35 years. Johnson & Johnson, one of the pharmaceutical companies pursuing the drug’s fast-acting antidepressant qualities, presented some promising new research on Saturday that could raise the drug’s profile as a potential treatment for […]

It’s a dramatic departure for a compound that most people know either as a surgical anesthetic or a party drug. And it’s a seemingly welcome one, according to physicians and psychiatrists who say they’ve grown tired of giving patients the same mediocre drugs for the past four decades.

J&J’s version of ketamine is a nasal spray made with a compound called esketamine, the chemical mirror image of ketamine. In its latest clinical trial, the company’s neuroscience partner, Janssen Research, wanted to show that the spray was safe, well tolerated, and superior to both a placebo and a traditional antidepressant.

To do it, the researchers had 236 adults with treatment resistant depression — known as one of the hardest forms to treat — take a traditional antidepressant for four weeks alongside a nasal spray. Only half of them got a spray with J&J’s drug in it; the other half got a placebo.

Their results were promising: The people who got the real spray saw significantly better improvements in their depressive symptoms than those who got the placebo, over the course of 28 days. More importantly, it is also the first time a novel treatment has come out on top even when compared to a traditional antidepressant drug.

The findings come roughly a month after J&J published the results of a small, preliminary version of this study which suggested that over the course of a single day, the spray and traditional antidepressant combo was better than a placebo and traditional antidepressant combo. That study, however, suggested the results diminished over the course of four weeks, while the longer and larger study suggests they might not.

The emerging science on ketamine

Depression is one of the world’s leading causes of death. Current treatments for depression, which take roughly five weeks to begin to take effect, may not work well in up to 80% of the people who get them.

Most existing antidepressants, from Abilify to Zoloft, work by plugging up the places where our brain takes up serotonin, a chemical messenger that plays a key role in mood. The result is more free-floating serotonin and, in some people, relief from a dark curtain of depressive symptoms.

Ketamine doesn’t work this way. It capitalizes on a different mechanism in the brain and affects key switches called NMDA receptors.

Like serotonin receptors, those for NMDA play an important role in our mood and help keep our emotions in check. But NMDA receptors also keep our brain’s synapses — the delicate branches that serve as the ecosystem for our thoughts — flexible and resilient.

Potentially because of depression’s damaging effects on these brain switches, it appears to cause our synaptic branches to shrivel up and in some cases even to die. Scientists think existing antidepressants send help to those branches indirectly over time by way of serotonin. Ketamine, by contrast, delivers its aid directly to the source, plugging up NMDA receptors like a cork in a bottle, and nipping depressive symptoms within hours.

Still, like any drug, ketamine has a range of unpleasant side effects, the most troublesome of which appears to be its tendency to produce what are known as dissociative, or “out of body,” experiences.

Experts worry those effects could lead patients to either react negatively to the experience and not want to repeat it, or react positively and want to repeatedly use, potentially leading to a drug-use disorder.

In J&J’s most recent study, patients reported other side effects as well, including dizziness, headache, blurred vision, and nausea.

The biggest unanswered question: long-term effects

Without a good number of long term studies on ketamine for depression, it’s tough to know what the drug’s effects might look like over the course of several months or years. Its beneficial effects, for example, could wear off; other negative side effects could emerge as well.

Allergan and VistaGen are currently doing long term studies of their new drug candidates, which act on the same pathway as ketamine but appear to have substantially fewer side effects; results from those trials are expected in the next two years.

J&J is also pursuing more research on its nasal spray ketamine formula, some of which will include longer trials. Company representatives told Business Insider that in addition to the research they’ve presented so far, they also have plans to study the nasal spray formula in teens with major depression who are at imminent risk for suicide.

The company is expecting to file for approval of their drug with the US Food and Drug Administration later this year.

Virginia Beach, Va. – Rana Culotta Simpson has suffered from depression most of her adult life. “I would sleep three days, at times 2-3 days not getting out of the bed,” says Culotta. This made it hard for the 35-year-old Peninsula resident to keep her job as a newspaper reporter. “I was socially anxious. I was phobic, paranoid. It was very hard to focus,” says Culotta. She`d tried antidepressants, but she wasn`t getting better. Eventually, she was placed on work disability. Then she found Dr. Katharine Heatwole at Ocean Psychiatric Group in Virginia Beach. It’s one of only 2 or 3 clinics in Hampton Roads treating patients with transcranial magnetic stimulation or TMS. “It’s pulse magnetic energy to the front left part of the brain, and that stimulates a little electrical current to the neurons or brain cells,” says Dr. Heatwole. “During my 1st treatment, I actually felt like there was someone tinkering or tapping on my head,” says Culotta. “That has a stimulation effect on the mood circuit so that it releases the neurotransmitters that are involved in mood,” says Culotta. “It is based on neuroplasticity and training the neurons to do what they are supposed to do in […]

By the time she was 61, Martha Rhodes had spent decades battling intractable depression. Diagnosis: treatment-resistant major depressive disorder. She’d tried a variety of medications to no avail; most were ineffective or caused nausea, diarrhea, weight gain and mood swings. During one particularly low evening in 2009, she attempted suicide. And every morning when she awoke, she experienced what she describes as “an emotional nausea – it was like this feeling of, ‘Why am I still here? Why do I have to be alive?’” But four years ago, Rhodes, now 65, of Danbury, Connecticut, underwent a procedure she says saved her life: repetitive transcranial magnetic stimulation, which uses magnetic pulses to electrically stimulate nerve cells in the brain and is used by doctors to relieve symptoms of depression. “My feelings of hopelessness, wishing I were dead and that life wasn’t worth living – all of that went away,” recalls Rhodes, who chronicled her experience with TMS in her 2013 book “3,000 Pulses Later.” Rhodes says she shares her story with others to demystify the treatment – which is often misunderstood by both patients and doctors, though it’s increasingly used by medical practitioners nationwide. What Is TMS? TMS was first developed […]

When you’re depressed, literally and figuratively stuck in a dark place, with no desire to get out and experience the world, it feels like time is inching by. Seconds feel like minutes, minutes feel like hours, and hours feel like days. Apparently, though, it’s not just a feeling. It’s a very real perception of time. New research from psychologists at the Johannes Gutenberg University of Mainz in Germany shows that depressed people actually experience time differently than healthy individuals. The scientists analyzed the results of 16 different studies examining 433 depressed subjects and 485 non-depressed control subjects. For the first part of the study, subjects were surveyed on their perception of time. “Psychiatrists and psychologists in hospitals and private practices repeatedly report that depressed patients feel that time only creeps forward slowly or is passing in slow motion,” reported study author Dr. Daniel Oberfeld-Twistel. The results of the meta-analysis confirmed that this is indeed the case. Then, for the second part of the study, they asked the subjects to subjectively estimate the length of a movie in minutes, press a button for five seconds, or identify the length of different sounds. In this case, the results obtained from the depressed […]

Researchers are launching a new trial to look into whether low doses of party drug ketamine can be used to treat alcoholics. The new study is recruiting volunteers to test whether low doses of ketamine help make psychological therapy more effective and prevent alcoholics from relapsing. A pilot study previously found that giving people doses of the drug as well as psychological therapy saw average 12-month relapse rates drop from 76% to 34%. Severe alcohol use affects nearly four million people in the UK. [Read the Full Article Here]

“They say [ketamine] should always be treated as a medicine and not be placed under United Nations illicit drug restrictions The World Federation of Societies of Anaesthesiologists is calling for global support for its initiative to protect ketamine’s status as an essential medicine for anaesthesia and pain relief.” [Read Full Article Here]

Saturday September 10th, 2016 was World Suicide Prevention Day. This is such an important conversation to continue having everyday. In 2016, Ketamine has been found to “clear up the distraught thinking of people on the brink of suicide”. It’s giving hope to many people with severe depression that has resisted traditional antidepressants. “We’ll see what history has to say about the role of ketamine over a longer period of time, but as it stands now, ketamine is revolutionary.“ [Read Full Article Here]

“A new study in Biological Psychiatry reports that esketamine, a component of the general anesthetic ketamine, shows rapid and significant improvement in depressive symptoms in patients who do not respond to currently available therapies.” [Read Full Article Here]

“Ketamine is an essential anesthetic and painkiller, especially in countries with limited options and poor storage facilities in their hospitals,” said WFSA president Dr. Jannicke Mellin-Olsen” [Read Full Article Here]

An interesting article on the wide range of symptoms used to diagnose depression: “the standard rating scales used by healthcare professionals and researchers to diagnose this disease often differ in the symptoms they list, perhaps explaining why a one-size-fits-all treatment has to date been so ineffective.” [Read Full Article Here]

If you’re looking for information about ketamine from a scientific research perspective a terrific article was published in The Lancet and the information is still very descriptive and accurate. Click the link below to view the PDF. [Read Full Article Here]

“A recent review led by Matthew Cooper of Dalhousie University, Canada, in ‘The World Journal of Biological Psychiatry’ examined all peer-reviewed reports on the use of ketamine to treat depression. The evidence is a mix of small trials and individual case reports, but collectively they build a powerful picture.” [Read Full Article Here]

A fascinating article in The Atlantic that tells the story of a neuroscientist on a mission to change how the brain and immune system handle stress. Her work shows tremendous promise for the use of ketamine in treating PTSD and stress-related mental illness. [Read the Article Here]

Ketamine makes #7 on Dr. Axe’s Top 10 Medical Innovations to Watch Out for in 2017 list! “7. Ketamine for Treatment-Resistant Depression More than 15 millions Americans over the age of 18 suffer from depression — that’s 6.7 percent of the adult population. (8) And while there are some natural remedies and prescription medications available, for nearly one-third of depressed patients, they don’t work. Unfortunately, for about 43,000 people, the answer becomes suicide. The medical world believes there is new hope in ketamine for these extreme, treatment-resistant cases. For the last few years, the animal tranquilizer and sometimes-party drug has been studied and trialled as a treatment for major depression when other options have been exhausted, and the results are promising. Of course, I am an advocate for natural depression treatment and improving mood and brain structure through food and exercise, but in some cases, even that fails to work. Numerous studies have found that ketamine is extremely effective in treating major depression, sometimes as quickly as in 24 hours after just one dose. (9) Serial ketamine infusions seem to be even more effective at treating the mental disease. (10) It works by targeting and inhibiting NMDA receptors in nerve cells. Thanks to […]

When should you, the prescriber, conclude that your patient with depression is “treatment resistant,” and thereby eligible for alternative non-pharmacological interventions—such as vagus nerve stimulation (VNS), electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS)? There are multiple ways that the failure to agree on a standardized definition of treatment-resistant depression (TRD) impacts the clinical care of patients who do not respond to multiple medication trials. In an article appearing in the January 2017 issue of JAMA Psychiatry, Charles Conway, M.D., Mark George, M.D., and Harold Sackheim, Ph.D., wrote that the lack of a consensus definition around what constitutes TRD “limits the ability to do comparative treatment research, to understand the biological underpinnings of TRD, and produces ambiguous medical insurance coverage issues.” Drawing on data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, they proposed a definition for TRD: failure to respond to two trials of an antidepressant prescribed at an adequate dose for an adequate duration of time. Conway, a professor of psychiatry and director of the Treatment Resistant Depression and Neurostimulation Clinic at Washington University, St. Louis, said that in the absence of a consensus definition of TRD, patients often receive multiple trials of medication. “Our experience has been that […]

How Ketamine Could Cure Depression The major excitatory neurotransmitter in the central and peripheral nervous system, glutamic acid, has been known for more than 50 years to produce its actions through various ionotropic channels (NMDA and AMPA) and G-coupled metabotropic receptors (mGluR 1 to 5). The glutamate-sensitive ion channels comprise multiple protein subunits and are subject to many regulatory and modulatory controls. Such intrinsic mechanisms are most apparent in the N-methyl D-aspartate (NMDA) receptor-operated ion channel which, in turn, offers countless opportunities for drugs to selectively exploit the ubiquity of glutamate’s excitatory role. Discovery of NMDA antagonists Considerable discovery efforts in the early 90s targeted various components of the NMDA receptor complex with the aim of developing new treatments for neurodegeneration – Alzheimer’s, Parkinson’s, Huntington’s diseases, stroke, traumatic brain injury – as well as epilepsy and pain, with some interest directed to psychiatric indications like anxiety. When the undesirable CNS side effects of many of these new drug candidates became apparent much of this research was curtailed, although several compounds with weak, or non-selective effects on the NMDA receptor were subsequently approved e.g. memantine, adamantine, methadone, and dextromethorphan. Return of the NMDA antagonist – the Ketamine breakthrough Targeting NMDA receptors came back into […]

WENCY LEUNG The Globe and Mail Published Thursday, Feb. 16, 2017 3:23PM EST Last updated Thursday, Feb. 16, 2017 5:18PM EST Inspired by promising research into ketamine’s therapeutic effects, people are swapping strategies online on how to use the drug to ease their despair. Could ‘Special K’ be a panacea for depression? Wency Leung reports John woke up one morning feeling almost like his old self. He got out of bed, took a shower and, for the first time in a long time, felt as though this day would not be his last. His suicidal thoughts had faded overnight. The previous morning, the 50-year-old Ottawa father of three was given his first intravenous infusion of the drug ketamine as part of a trial for people with treatment-resistant depression. John (not his real name) had tried various medications for his depression over the years – without improvement. But within hours of receiving his first ketamine infusion, he began feeling better. “I started feeling the benefits almost right away,” he said. By the next morning, “not completely, but I felt like I could behave like the normal man that I used to be.” [Read More]

A Very Moving and Well Written Account from a Healthcare Professional and Parent As both a healthcare professional and a parent of a child who suffers from treatment resistant depression and anxiety, I have been quite attentive to the changes that arise in an individual after receiving low-dose ketamine. I thought it would be helpful to share my observations with others who are contemplating offering this innovative treatment in their practices or for those that may be exploring ketamine as an option in treating their own depression. Though low-dose ketamine can alleviate suicidal thoughts immediately and lift an individual from feelings of despair which many have suffered for years, it does not cure one’s depression indefinitely. Ketamine, in my experience, has worked in a way that it offers hope to individuals and provides a new found resilience in dealing with life stressors. As an outsider looking in, I have watched my child develop the drive and passion to discover new approaches to help improve her mental health and overall well-being. I have been quite focused on my child’s state of mental health since her return back to college and found that the negative thoughts and depression started to creep back […]

Depressive Symptoms Associated With Aggression Violence is not usually considered to be related to depression, yet findings suggest an association between violent behavior and depression or depressive symptoms in many different disorders. A Swedish study compared the criminal records of 47,158 depressed individuals with the records of 898,454 people with no history of depression matched by age and sex.1 Those in the depressed group were approximately 3 times more likely than the general population to commit violent crimes, such as homicide, attempted homicide, aggravated assault, or robbery. This association was present even when previous histories of violence, self-harm, psychosis, and substance use were taken into consideration. Furthermore, the risk of violent crime significantly increased in individuals with more depressive symptoms. [Read the Full Article Here]

Ketamine the Next-Gen Treatment “There are key questions right now concerning both the scientific understanding of ketamine and the potential future use of ketamine or ketamine-like drugs for depression,” Dr Murrough told Medscape Medical News. One question is how ketamine triggers an antidepressant response within 1 day, whereas conventional antidepressants require 2 weeks or longer to take effect. “What is the biological basis of ketamine’s antidepressant mechanism of action?” he asked. It also remains a mystery why ketamine is successful in treating symptoms of depression in patients who have not responded to conventional treatments. “What can ketamine do in the brain that is relevant to the treatment of depression, that current antidepressant drugs do not do?” asked Dr Murrough. [Read the Full Article Here]

Several research teams around the world have been trialing ketamine use in chronic and recurring depression Thomson Reuters Posted: Apr 06, 2017 5:04 PM ET Last Updated: Apr 06, 2017 5:15 PM ET The party drug ketamine can have powerful beneficial effects on severely depressed patients who have struggled for years to recover, and the drug should be developed responsibly as a psychiatric medicine, British experts said on Thursday. In a study published in the Lancet Psychiatry journal, specialists from Oxford University said there is an urgent need for ethical and innovative action by doctors to prescribe the drug under controlled conditions. “We think patients’ treatment should be in specialist centers and formally tracked in national or international registries,” said Rupert McShane, a consultant psychiatrist and researcher at Oxford who has led a series of ketamine studies. [Read the Full Article Here]

One patient says drug slows down the ‘constant, overwhelming bombardment of negative intrusive thoughts surging through your brain’ Katie Forster Health Correspondent @katieforster Ketamine can provide relief to patients with severe depression “where nothing has helped before”, researchers calling for a new approach to the drug’s medical use have said. For six years, scientists from Oxford University have been using ketamine to treat more than 100 people with treatment-resistant depression. They said patients who received a series of carefully administered intravenous infusions of the drug, followed by oral top-ups, showed sustained improvement in around 40 per cent of cases – a significant result when other antidepressants have failed. “There are lots of people who are currently resistant to antidepressant drugs and psychotherapies,” consultant psychiatrist Rupert McShane told The Independent. “We’d like to see some more centers developing expertise [about ketamine] and starting to use it.” [Read the Full Article Here]

Ketamine, introduced in 1966 as an anesthetic, is increasingly showing up in private clinics nationwide as a treatment for chronic pain. While the drug is indeed a potent pain reliever, its effect is short-lived; and use may be accompanied by headache, nausea, and fatigue, among other adverse outcomes. There also is a risk of abuse given ketamine’s euphoric properties, which have earned it a reputation as a club drug. For these and other reasons, clinicians are apprehensive about pain centers administering off-label ketamine infusions for conditions ranging from fibromyalgia to migraines. The jury is still out, they say, on whether ketamine is a viable option for pain management. While some studies have reported a benefit, the quality of the evidence is low due to the small scale, limited generalization, and lack of effective blinding in these investigations. Moreover, research evaluating ketamine for chronic pain has focused on I.V. infusion, which inflates the cost of treatment and limits its use over the long term. The American Society of Regional Anesthesia and Pain Medicine is expected to issue guidelines on ketamine use for pain management within 6 months, but University of Pittsburgh anesthesia and psychiatry professor Ajay Wasan, MD, says clinicians will […]

Over the past 15 years the treatment of Depression and related illnesses has undergone a myriad of changes. A milestone that had a significant impact was the effective use of Genomic testing that assisted in utilizing psychotropic medications in a systematic and scientific fashion. Here, the experience of the physicians was augmented by the genetic information about the patient and a better decision was reached in selecting the proper medication(s). This often resulted in a larger number of patients reaching greater degrees of emotional stability more rapidly and with fewer untoward effects. It has been noted that approximately 75% of patients can now reach a state of remission. The World Health Organization has stated that over 350 million people in the world suffer from Depression. In the United States in 2012, the NIMH (National Institute of Mental Health) reported 6.9% of the population (16 million) suffered from at least one major episode of Depression. If you factor in those suffering from the depressive aspects of PTSD, Chronic Pain, Bipolar Disorders and Post Partum Disorders, these numbers drastically increase. Early diagnosis and scientifically based treatment can facilitate successful treatment to reach or surpass the 75% referenced above. The remaining 25% are […]

Jesse Tahirali, CTVNews.ca Published Sunday, January 25, 2015 10:10PM EST The grey clouds of depression are difficult to shake. Approximately eight per cent of Canadian adults will experience a major depression at some point in their lives, according to Toronto’s Centre for Addiction and Mental Health. Medication often fails to temper the debilitating effects of the illness. Only one third of patients report improvement after their first round of treatment, and some fail to improve regardless of what they’re prescribed. Gail Bellissimo, a Mississauga mother of four, was one of those people who still suffer even after seeking help. “I tried just about every drug out there, antidepressant of all kinds,” Bellissimo said. “They just either didn’t work for me or the side effects were too much for me to take.” But after years of living through the lows, Bellissimo said it only took three minutes to pick her up out of her depression. She was driving home when her new treatment began to take effect. “It was so unnerving at first,” she said. “At first it was like, “Wow, is this what it feels like to be normal?’” Bellissimo participated in a four-week study for something called theta-burst stimulation, […]

The FDA recently granted 510k clearance to market MagVita TMS therapy, a repetitive transcranial magnetic stimulation system, for treatment of depression. “The new FDA cleared MagVita TMS Therapy system is tailor-made for health care professionals seeking an entry-level TMS system without having to compromise on quality and safety,” Kerry Rome, BS, vice president of sales at MagVenture Inc, said in a press release. The MagVita TMS therapy system was first cleared by the FDA in 2015 for treatment of major depressive disorder. [Read the Full Press Release Here]

Analysis of FAERS data finds less comorbid depression among pain patients on ketamine by Neel A. Duggal Contributing Writer, MedPage TodayMay 12, 2017 An analysis of data from the FDA Adverse Events Reporting System (FAERS) supported previous findings that ketamine could be an effective treatment for depression, researchers found. Given financial and ethical obstacles to a large randomized controlled trial of ketamine for depressive disorders, Ruben Abagyan, PhD, of the University of California San Diego, and colleagues decided to turn to AERS data on patients taking ketamine for pain, an FDA-approved use. They found that patients who took ketamine had significantly lower frequency of reports of depression than those taking any other drugs for pain, according to findings published in Scientific Reports. “This reduction in depression is specific to ketamine and is known to be much more rapid than current antidepressants, making this observed effect very promising for treatment of patients with acute depressive or suicidal episodes,” Abagyan and colleagues wrote. [Read the Full Article Here]

Shape Magazine Recently Covered Ketamine as a Depression Treatment By Rachel Jacoby Zoldan | May 16, 2017 Depression is more common than you might think. It affects more than 15 million Americans, and the World Health Organization estimates that number grows to 300 million when you expand globally. There are a slew of different treatment options available to help alleviate its symptoms—think anxiety, insomnia, fatigue, and loss of appetite among others—with the most common treatment being serotonin reuptake inhibitors (or SSRIs). But since about 2000, doctors and researchers have been experimenting with ketamine—originally a pain management pharmaceutical, now abused as a street drug because of its hallucinogenic effects—as another potential way to treat the condition, according to Ruben Abagyan, Ph.D., a pharmacology professor at the University of California San Diego (UCSD). You’re probably thinking, “Wait! What?” If you’ve heard of ketamine, also known as Special K, you know it’s no joke or generic OTC drug. In fact, it’s known as a dissociative anesthetic (meaning a drug that distorts perception of sight and sound, while producing literal feelings of detachment from the self and the environment). It’s primarily used by veterinarians for treating pain in animals, but it can also be […]

There’s More Proof That Ketamine Works for Depression For decades, scientists have searched for a new type of antidepressant, one that works differently from the 20-plus drugs already on the market. Finding a new option is crucial, since a third of people don’t respond to available depression treatments. They haven’t had much luck — except for the discovery that IV infusions of ketamine hydrochloride, an FDA-approved anesthetic, can cause rapid antidepressant effects in many people with stubborn depression. Figuring out exactly how ketamine has these effects has been a researcher’s dream, since ketamine is too problematic a drug to currently be considered a mainstream depression treatment. It’s illicitly used — and abused — as a psychedelic club drug and can cause hallucinations. Ketamine can also have negative side effects when used off-label to treat depression, including unexpected changes in heart functioning, cognition and respiration. Its antidepressant effects fade, so it typically has to be given over and over again, and it’s not yet clear how safe or effective it is when taken long-term. Developing a drug that works like ketamine, but without all the baggage, is the holy grail — but scientists haven’t known quite what to target. Now, in […]

Scientists have identified a key protein that helps trigger ketamine’s rapid anti-depressant effects in the brain, a crucial initial step to developing alternative treatments to the controversial drug being dispensed in a growing number of depression clinics across the country. Ketamine is drawing intense interest in the psychiatric field after multiple studies have demonstrated it can quickly stabilize severely depressed patients. But ketamine – illicitly used for its psychedelic properties – could also impede memory and other brain functions, spurring scientists to identify new drugs that would safely replicate its anti-depressant response without the unwanted side effects. A new study from the Peter O’Donnell Jr. Brain Institute has jumpstarted this effort in earnest by answering a question vital to guiding future research: What proteins in the brain does ketamine target to achieve its effects? “Now that we have a target in place we can research the pathway and develop drugs that safely recreate the anti-depressant effect,” said Dr. Lisa Monteggia, Professor of Neuroscience at UT Southwestern Medical Center’s O’Donnell Brain Institute. The study published in Nature shows that ketamine blocks a protein responsible for a range of normal brain functions. The blocking of the N-methyl-D-aspartate (NMDA) receptor creates the initial […]

PASWFL’s New Treatments for Depression Showcased on ABC TV Show PASWFL was featured on Out and About Southwest Florida. We had a chance to film and take photos of our beautiful facility as well as discuss the different treatment options we’re proud to offer people in Southwest Florida and surrounding communities. Check out the video tour of our office below: And more images of our comfortable treatment rooms:

LOS ANGELES, July 11 — Doctors in California say magnetic stimulation can help ‘rewire’ the brains of people withdepression, offering hope for patients whose condition is not improved by medication or therapy. Depression is one of the most common forms of mental illness, affecting more than 350 million people worldwide. Bob Holmes is one of them. “I struggled with that for many years, didn’t know really what to do, tried to pull myself through it. And then ultimately when I got into my forties, I wasn’t successful.” Holmes has been receiving transcranial magnetic stimulation at the University of California Los Angeles, a treatment that beams targeted magnetic pulses deep inside his brain. Doctors say the therapy can effectively ‘rewire’ the brain by changing how brain circuits are arranged. Reuters Video: Doctors hope to ‘rewire’ depressed people’s brains: [Read the Full Article Here]

Ketamine has ‘truly remarkable’ effect on depression and is effective in elderly patients, scientists say. After six months, 43% of the subjects said they had no significant symptoms of depression. Katie Forster Health Correspondent @katieforster Wednesday 26 July 2017 08:38 BST Ketamine can have a “truly remarkable” effect on people with depression, researchers have said after a new study showed promising results among elderly patients. Colleen Loo, a professor at the University of New South Wales in Australia, led the world’s first randomised control trial into the drug’s effect on people over 60 with treatment-resistant depression. “This trial has shown ketamine can be used safely in the elderly and it tends to be effective,” she told The Independent, adding that a similar effect was observed in this age group as in younger patients. It is important to test how people of different ages respond to a new treatment before it can be offered by doctors, she said: “Sometimes depression in the elderly can be harder to treat, especially with medication. “Also, they tend to have more medical problems, which can interfere with medication.” Ketamine was discovered in 1962 and is licenced for medical use in the UK as an anaesthetic, but is also used […]

New Hope for Depression Mandy Oaklander Jul 26, 2017 TIME Health For more, visit TIME Health. Every week, when Ian Hanley sits down with his therapist, he goes through a list of depression treatments he’s been researching online. The best-known treatments at the top of the list–half a dozen antidepressants and known combinations of those drugs–are all crossed out. “My therapist says he’s never had this much difficulty with somebody,” says Hanley, “which is sort of a dubious honor.” Hanley is only 21 years old, but he’s already six years into his search for something, anything, that can help him feel better for more than a few weeks at a time. “I’ve heard people describe it as sadness, and that’s not specific enough,” he says. Numbness is closer, but it’s not like depression inures you to suffering. “It’s like not quite being alive,” he says, “but still having to go through all the crappy parts of being alive.” When he was in the 10th grade, Hanley basically lost all desire to get out of bed in the morning. He started seeing a psychiatrist and a therapist–the same one he sees today–and went on Zoloft. “I wasn’t catatonic anymore,” he says. But […]

Patrice Wendling August 03, 2017 MURRAY, UT — Depression and coronary artery disease are known to walk hand in hand, but a new study suggests that depression any time after a diagnosis of CAD is the strongest predictor of death[1]. Among 24,137 patients identified with significant CAD, a new depression diagnosis was associated with a twofold higher risk of all-cause death after multivariable adjustment, the investigators reported in the European Heart Journal Quality of Care and Clinical Outcomes. “It was stronger than any follow-up events, stronger than diabetes, stronger than smoking, sex, prior diagnosis of high blood pressure or depression, and even whether they had a heart attack,” lead author Dr Heidi T May (Intermountain Heart Institute, Murray, UT) told theheart.org | Medscape Cardiology. “I thought it would be a significant predictor, but I didn’t anticipate it would be the strongest. “I would think most people would find that amazing.” She said the results emphasize the need for continual depression screening among all CAD patients, but an accompanying editorial[2] notes that recommendations by the American Heart Association (AHA) for routine screening in patients with heart disease have been met with some opposition, in large part because of a lack of studies showing a survival benefit with depression treatment. “Given the […]

By Meredith WadmanAug. 29, 2017 , 3:30 PM Luca Rossi tried to hang himself in a bedroom in Perugia, Italy, in 2012. Suspended by his belt from a wardrobe, he had begun to choke when his fiancée unexpectedly walked in. He struggled to safety, defeated even in this intended last act. The 35-year-old physician had everything to live for: a medical career, plans for a family, and supportive parents. But Rossi* was addicted to crack cocaine. He had begun his habit not long after medical school, confidently assuming that he could control the drug. Now, it owned him. Once ebullient and passionate, he no longer smiled or cried. He knew he might be endangering his patients, but even that didn’t matter. He was indifferent to all except obtaining his next fix. “It pushes you to suicide because it fills you with your own emptiness,” he says. In the first months after his near suicide, Rossi didn’t drop his $3500-a-month habit. Early in 2013, he learned that his fiancée was pregnant. Frightened by impending fatherhood, he smoked even more. He didn’t—couldn’t—stop. Then, in April 2013, Rossi’s father, a chemist, happened upon a local newspaper article describing work just published in Nature. […]

William Storey remembers a childhood filled with hopelessness and loneliness instead of birthday parties and bike rides. “I was abnormal at an age in which abnormality is very unhealthy,” states William, now 23. The abrupt and dramatic cultural change caused by his family’s move from Maine to Georgia when he was eight complicated the challenges William already faced. Over the years, he’s been diagnosed with attention deficit hyperactivity disorder, bipolar disorder, severe depression and Asperger’s syndrome, a higher – functioning form of autism. Generally, Asperger’s patients struggle to communicate with and relate to others. They may lack empathy and have difficulty reading other people’s moods and making friends. During his early years in private school, William felt isolated and misunderstood, especially by classmates, and by teachers who disciplined him for “being out of control.” He explains the mindset of those teachers this way: “I like to think of it as, This nail doesn’t seem to be fitting into this particular piece of wood quite the same way the rest of them do, so we should probably hit it more.” By the time he reached fourth grade, William wanted to die. “I hated my life,” he recalls. “I hated everything.” In […]

Post-Traumatic Stress Disorder (PTSD) has a reputation for being difficult to treat, especially in active duty military and veteran populations. That may soon change, according to research findings shared Wednesday at the 2017 San Antonio Combat PTSD Conference. There are two medications approved by the Food and Drug Administration to treat PTSD: Zoloft and Paxil. Both are part of a class of antidepressants known as selective serotonin reuptake inhibitors. They’re only modestly effective and take about 10 weeks to set in. Outcomes have been poor in military and vet populations, particularly in people with chronic, multi-trauma PTSD. A new kind of treatment is gaining traction. It’s ketamine, a medication mainly used to start and maintain anesthesia. On Wednesday a group of leading researchers gathered at the San Antonio Combat PTSD Conference, presented by STRONG STAR and the Consortium to Alleviate PTSD, two programs of UT Health San Antonio. Dr. John Krystal, Chair of the Psychiatry Department at Yale University, studies ketamine’s effects on the brain. In his keynote address, Krystal said that ketamine works fast to relieve symptoms of depression in trials, with some patients showing a complete turnaround after just one intravenous dose. “This idea of people with chronic, treatment resistant depression–multiple treatments: psychotherapies, […]

Published Thursday 26 October 2017 By Tim Newman Fact checked by Jasmin Collier According to a recent study, although treating major depressive disorder has benefits in the short-term, over a longer period of time, it may make the condition worse. Major depressive disorder is a serious, debilitating mental illness. In the United States, it affects more than 16.1 million people over the age of 18. Although its prevalence is high, it is still a difficult condition to treat. Treatments include medications such as selective serotonin re-uptake inhibitors and talking therapies, such as cognitive therapy. No case of depression is the same, and often, individuals receive a range of treatments across their lifetime. How well the treatment of depression works has come under scrutiny over recent years, and the debate is by no means over. The latest study, published in the journal Psychotherapy and Psychosomatics, adds another dimension to this ongoing conversation. Clinical Treatment Compared with Community Individuals with major depressive disorder who receive medication or cognitive therapy often see a reduction in their depressive symptoms and experience significantly longer times before relapse. But over the longer-term, the picture is less clear. This is primarily because studies generally only run for […]

John Foster, like many who have served our country, has dealt with the lasting effects of war, especially post-traumatic stress disorder (PTSD). The 38-year-old says a genetic test, ordered by his doctor, helped guide his treatment plan and allowed him to get better, faster. The Orlando, Florida, resident was a combat medic and served two tours of duty in Iraq. He says the first tour, in 2004 and 2005, left him with no problems…or so he thought. It was during the second tour, in 2006 and 2007, when his issues developed. This is when the Army extended tours as a part of the troop surge. During John’s deployment, 11 members of his unit were killed in the deadliest year of the war on terror. Foster’s PTSD has required both inpatient and outpatient treatment. Through the years, he’s dealt with the frustration of discovering that many psychiatric drugs don’t work for him: at one point taking as many as 13 different medications a day. “My doctor, Dr. Robert Pollack, was able to adjust my meds and recommend supplements to more effectively help me deal with the situation…the Genecept Assay® was key for me to help unlock the personal information that I needed […]

RENO, Nev (KOLO) The clear plastic IV bag contains saline and a small amount of Ketamine. Two times a week, Samantha Cobb is hooked up to the medicine for about 40 minutes. A chronic pain patient with depression, she says within hours she feels like a million bucks. “For the past four years I haven’t been able to walk without a brace or a crutch. Some days I couldn’t get out of bed, the pain was so bad. But these last couple of weeks, it’s been, I don’t even have the words to describe it. I mean, it has literally been a miracle,” says Samantha. Samantha says she had heard about Ketamine treatments and did her research. But until about three months ago, there was no such clinic locally to help her. That all changed with Sierra Ketamine Clinic. “Many of our patients are at wit’s end. They have given up on life in many regards. To see many people do a 180, really, and pick up the pieces of their life and move forward, with a smile on their face, is pretty impressive,” says Dr. Bret Frye with Sierra Ketamine Clinic. Dr. Frye says typically Ketamine has been used as […]

Publish date: December 8, 2017 By Randy Dotinga Clinical Psychiatry News Ketamine, once best known as a pet anesthetic and party drug, is taking the United States by storm. Dozens of ketamine treatment centers are operating from coast to coast.Big cities like Baltimore, Boston, and Phoenix have them. So do Charleston, S.C., and Boise, Idaho. Two such clinics are in sparsely populated New Mexico. And one national chain went from a pair of clinics to 10 in fewer than 2 years. Dr. Jeffrey Lieberman “There’s been a mad rush on the part of desperate patients to seek care,” said ketamine researcher Jeffrey A. Lieberman, MD, chair of the psychiatry department at Columbia University, New York; director of the New York State Psychiatric Institute; and a past president of the American Psychiatric Association. Never mind that these expensive treatments for conditions like depression are not covered by insurers or approved for this use by the Food and Drug Administration. Other questions also persist. “There is a considerable body of evidence that proves it really does work,” Dr. Lieberman said. “But we don’t know the extent of the range of conditions for which it might be effective, what the optimal frequency and concentration for dosing is, […]

Publish date: December 14, 2017 By Randy Dotinga Clinical Psychiatry News SAN DIEGO – High-potency marijuana use appears to be associated with an increased risk of a first psychotic episode, based on a case-control study conducted in Europe. “Daily users of a strong type of cannabis face a significant increase in the probability of developing a psychotic disorder,” reported Marta Di Forti, MD, PhD, MRC, lead author of a study whose preliminary results were presented at the International Congress on Schizophrenia Research. Dr. Di Forti spawned a media boomlet in 2015 when she and her colleagues raised the prospect of a possible association between so-called “skunk” marijuana and first psychotic episodes. In their study of subjects in London with first-time psychotic episodes and matched population controls, those who had psychotic episodes were three times (adjusted odds ratio: 2.92; 95% confidence interval, 1.52-3.45; P = .001) as likely as controls to have used “skunk” marijuana (Lancet Psychiatry. 2015 Mar;2[3]:233-8). In the new study, Dr. Di Forti and her colleagues analyzed 1,200 first-incident cases of psychosis that were captured between the years 2010 and 2013 by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions project (EU-GEI). The researchers compared the cases to 1,300 population-based controls in […]

Question: How do effects of genetics and rearing each contribute to the transmission of risk for major depression from parents to children? Findings: In this population register–based study of 2 269 552 offspring of intact, adoptive, not-lived-with father, stepfather, and triparental families from the general Swedish population, the effects of genes and rearing were approximately equal for parent-offspring resemblance for major depression. Genetic and rearing effects acted additively on offspring risk for major depression. Meaning: Genetic and rearing effects are important in the cross-generational transmission of major depression. Importance Twin studies have assessed sibling resemblance for major depression (MD) but cannot address sources of resemblance across generations. Objective To clarify the relative importance of genetic and rearing effects on the parent-offspring resemblance for MD. Design This Swedish population register–based study examined parents and children from the following 5 family types: intact (2 041 816 offspring), adoptive (14 104 offspring), not-lived-with (NLW) father (116 601 offspring), stepfather (67 826 offspring), and triparental (29 205 offspring). The 5 family types permitted quantification of parent-offspring resemblance for genes plus rearing, genes-only, and rearing-only associations. Treated MD was assessed from national primary care, specialist care, and inpatient registries. Data were collected from January 1, 1960, through […]

Abstract The aim of this open study was to evaluate the safety and tolerability of theta-burst transcranial magnetic stimulation (TBS) and to assess preliminarily its therapeutic efficacy in patients with major depression. A total of 33 patients were assigned to receive one of four TBS protocols for 10 consecutive work days. TBS consisted of triple-pulse 50-Hz bursts given at a rate of 5 Hz to the left or right dorsolateral prefrontal cortex at different stimulation parameters. Severity of depression was assessed by the Hamilton Depression Rating Scale. Our results indicate that TBS as applied in this study is safe and well tolerated in depressed patients and seems to have antidepressant properties. Increase of stimulation parameters is not associated with more side-effects and adds to its therapeutic effect. Introduction In the last two decades, repetitive transcranial magnetic stimulation (rTMS) has been studied as a therapeutic tool in several neuropsychiatric disorders, primarily for the treatment of major depression (MD) where it has shown a consistent and reproducible therapeutic effect (Feinsod et al.1998; George et al.1997, 1999; Pascual-Leone et al.1996). Previous studies have demonstrated that left high-frequency (⩾5 Hz) (George et al.2000) and right low-frequency (⩽1 Hz) (Klein et al.1999) rTMS to the prefrontal cortex (PFC) is effective in […]

Repetitive transcranial magnetic stimulation (rTMS) is a novel, non-invasive method of activating neural signals through the use of strong, time-varying electromagnetic fields. rTMS is primarily used for patients with treatment-resistant depression. As its reputation has grown, so has its demand. But in the world of health economics and Return on Investment (ROI) ratios, is rTMS a viable option for the millions of people suffering from depression? To date, no such analysis has examined the cost-effectiveness of rTMS as a first line or at least an earlier treatment option over a patient’s lifetime. To investigate this question, Voight and Leuchter (2017) used Markov simulation modeling to analyze direct costs and quality adjusted life years (QALYs) of rTMS versus medication therapy in patients with newly diagnosed Major Depressive Disorder (MDD) who were age 20-59 and had not improved after a single pharmacotherapy trial. Response and remission rates, quality of life outcomes and life expectancy were culled from the scientific literature. The baseline for treatment costs was derived from federal Medicare reimbursement data. Additional baseline data included QALYs, assessment of superiority, analysis of instrument sensitivity, and lastly, a discount rate of 3% was applied. The results of this complicated health/economic analysis revealed the […]

Melissa Banks says she struggled with depression “on and off, but mostly on” since the age of ten. She traces the cause to early life experiences, and while she doesn’t have a personal recollection of the details, her mother has helped fill the gaps in her memory.“My twin brothers were born when I was not quite two,” Melissa shares. “My life until that point had been great. I was part of a young family, was the first daughter and everything was wonderful. Then, when my brothers were born, my mom suffered from postpartum depression. She now had three kids under two. One had food allergies, which they didn’t know anything about in 1974. “My physical needs got met, but attention and affection were pretty much withdrawn at that age,” Melissa continues. “And then my parents split up when I was nine and divorced when I was ten.” Melissa’s mother was busy with a full-time job 30 miles from home, and then with her pursuit of a Master’s degree at a college 120 miles away. Melissa took care of her brothers and kept house. “I was a stay-at-home mom when I got home from school,” she remarks. “I never really felt […]

Getting the Inside Dope on Ketamine’s Mysterious Ability to Rapidly Relieve Depression The notorious party drug may act as an antidepressant by blocking neural bursts in a little-understood brain region that may drive depression By Simon Makin on March 2, 2018 Ketamine has been called the biggest thing to happen to psychiatry in 50 years, due to its uniquely rapid and sustained antidepressant effects. It improves symptoms in as little as 30 minutes, compared with weeks or even months for existing antidepressants, and is effective even for the roughly one third of patients with so-called treatment-resistant depression Although there are multiple theories, researchers do not quite know how ketamine combats depression. Now, new research has uncovered a mechanism that may, in part, explain ketamine’s antidepressant properties. Two studies, recently published in Nature, describe a distinctive pattern of neural activity that may drive depression in a region called the lateral habenula (LHb); Ketamine, in turn, blocks this activity in depression-prone rats. Originally licensed as an anesthetic in 1970, ketamine has since gained fame as a party drug for causing out-of-body experiences, hallucinations and other psychosislike effects. Its antidepressant properties in humans were discovered almost 20 years ago. Ketamine does not directly influence the same chemical messengers as standard antidepressants such […]

An interesting and unusual approach to migraines in a difficult population: Credits: Samantha L. Irwin MSc, MB BCH BAO, FRCPC, William Qubty MD, I. Elaine Allen PhD, Irene Patniyot MD, Peter J. Goadsby MD, PhD, Amy A. Gelfand MAS, MD First published: 12 March 2018 [Buy the Full Research Article HERE] Abstract Objective To assess the feasibility, tolerability, and patient acceptability of single-pulse transcranial magnetic stimulation (sTMS) for migraine prevention in adolescents in an open-label pilot study. Background Migraine is common in adolescents and can be disabling. Well tolerated preventative therapies that are safe and effective are needed. Methods This was an open-label prospective pilot feasibility study of sTMS for migraine prevention in adolescents aged 12-17 years. Participants used sTMS twice daily in a preventative fashion, as well as additional pulses as needed acutely. A 4-week baseline run-in period (weeks 1-4) was followed by a 12-week treatment period. Feasibility was the primary outcome. Secondary outcomes included tolerability and acceptability, as well as the change in headache days, number of moderate/severe headache days, days of acute medication use, and PedMIDAS (headache disability) scores between the run-in period (weeks 1-4) and the third month of treatment (weeks 13-16). Results Twenty-one participants enrolled. Nineteen completed […]

Healing Then and Now With Music Therapeutic uses of music date back to antiquity. Healing shrines in Ancient Greece housed both hymn specialists and physicians.[2] Native American tribes chanted, danced, and played drums to heal illness. And early Christian priests used hymns to ease pain in the sick. Today, scientific studies confirm what the ancients seemed to know inherently: that music can be medicinal.[3] The Ancient Greeks: Musical Wisdom Hippocrates advocated a “healthy mind in a healthy body,” which included mental health care and art therapy. Music and drama were used to treat illness and improve behavior in his time. The notion was that healing the soul through music would also heal the body, with specific applications. The sounds of the flute and harp, for instance, were a treatment for gout.[5] What Is Music Therapy? A Contemporary Definition Today, music therapy aims to influence both emotion and physiology. Music therapy is an established allied healthcare profession that entails a therapeutic relationship between a patient and a board-certified music therapist. Treatment techniques are designed to achieve functional changes in mood, brain, and behavior.[6] Imaging Studies: The Brain Dances to Music Music modifies brainwaves, a phenomenon that can be seen through functional […]

“Depression researchers at Black Dog Institute and University of NSW had to abort a “promising” pilot trial into the efficacy of ketamine nasal sprays after patients experienced psychotic-like effects and temporary loss of fine motor skills. The researchers were hopeful the trial would work as an earlier study in the US had shown ketamine – an anaesthetic drug shown to have rapid antidepressant effects – could be safely delivered using a nasal spray. But in a paper published in the latest Journal of Psychopharmacology, the research team, led by Professor Colleen Loo, said they had to stop the trial at five participants with severe depression (they were aiming for 10) because of unexpected side effects – their blood pressure shot up, they became uncoordinated and they suffered “unpleasant” psychotic-like effects.” The quote above is an exerpt from an article in the Sydney Morning Herald. To read the full article please click HERE. To read the original study in the Journal of Psychopharmacology that the Sydney morning herald is discussing, please click HERE.

Three-minute magnetic brain stimulation treatments can reduce depression symptoms: study A three-minute treatment involving magnetic stimulation of the brain works just as well as the standard form of such therapy for people with hard-to-treat depression, a new study has found. The success of the intermittent theta-burst stimulation (iTBS) therapy could greatly increase the number of patients treated, according to one Canadian psychiatrist who provides the treatment at Toronto’s Centre for Addiction and Mental Health (CAMH). “A significant number of people can stand to benefit from this treatment that is an alternative to medications and works when medications have not worked,” Dr. Daniel Blumberger, the co-director of CAMH’s Temerty Centre for Therapeutic Brain Intervention, told CTV News. Theta-burst stimulation is a more powerful type of repetitive transcranial magnetic stimulation (rTMS), a proven form of treatment for illnesses like depression. A study co-authored by Dr. Blumberger and published in The Lancet found that theta-burst stimulation can reduce symptoms of severe depression just as well as the standard rTMS treatment. In the study of about 400 patients from Ontario and British Columbia with treatment-resistant depression, 49 per cent experienced a reduction in symptoms after receiving the three-minute therapy delivered daily over four to six weeks. […]

Ketamine, which has been called “the most important discovery in half a century,” just got a step closer to becoming the first new depression drug in 35 years. Johnson & Johnson, one of the pharmaceutical companies pursuing the drug’s fast-acting antidepressant qualities, presented some promising new research on Saturday that could raise the drug’s profile as a potential treatment for the condition. It’s a dramatic departure for a compound that most people know either as a surgical anesthetic or a party drug. And it’s a seemingly welcome one, according to physicians and psychiatrists who say they’ve grown tired of giving patients the same mediocre drugs for the past four decades. Johnson & Johnson isn’t the only drugmaker that’s hot on the ketamine trail. Allergan is in the last phase of clinical trials with a drug that acts on the same receptor as ketamine, and San Francisco drugmaker VistaGen is studying a similar ketamine-inspired drug. J&J’s version of ketamine is a nasal spray made with a compound called esketamine, the chemical mirror image of ketamine. In its latest clinical trial, the company’s neuroscience partner, Janssen Research, wanted to show that the spray was safe, well tolerated, and superior to both a placebo and a traditional antidepressant. To do it, the researchers had […]

4-point cut in MADRS scores versus placebo after 4 weeks by Kristen Monaco, Staff Writer, MedPage TodayMay 09, 2018 NEW YORK CITY — Intranasal esketamine paired with an oral antidepressant improved symptoms of treatment-resistant depression, researchers reported here. When compared to intranasal placebo plus an antidepressant, two phase III studies found twice-weekly flexibly-dosed intranasal esketamine added to a newly initiated antidepressant showed some benefit for depressive symptoms among adult and elderly populations, respectively, who had previously failed at least two prior treatments. Presented at the annual meeting of the American Psychiatric Association, both analyses were led by Larry Alphs, MD, PhD, of Johnson & Johnson, and colleagues. “Esketamine is thought to affect the glutamate system in the brain and is part of a class of investigational medicines known as glutamate receptor modulators,” explained co-author David Hough, compound development lead for esketamine at Janssen Research & Development, to MedPage Today. Esketamine is a chirally pure enantiomer of the anesthetic agent ketamine, which has shown promise for rapid relief of severe depression in previous studies. However, ketamine is available only as an IV drug. Janssen focused on esketamine “because it could be formulated as an intranasal medicine, thus potentially allowing appropriate patients in need to have access to […]

Background Treatment-resistant major depressive disorder is common; repetitive transcranial magnetic stimulation (rTMS) by use of high-frequency (10 Hz) left-side dorsolateral prefrontal cortex stimulation is an evidence-based treatment for this disorder. Intermittent theta burst stimulation (iTBS) is a newer form of rTMS that can be delivered in 3 min, versus 37·5 min for a standard 10 Hz treatment session. We aimed to establish the clinical effectiveness, safety, and tolerability of iTBS compared with standard 10 Hz rTMS in adults with treatment-resistant depression. Methods In this randomised, multicentre, non-inferiority clinical trial, we recruited patients who were referred to specialty neurostimulation centres based at three Canadian university hospitals (Centre for Addiction and Mental Health and Toronto Western Hospital, Toronto, ON, and University of British Columbia Hospital, Vancouver, BC). Participants were aged 18–65 years, were diagnosed with a current treatment-resistant major depressive episode or could not tolerate at least two antidepressants in the current episode, were receiving stable antidepressant medication doses for at least 4 weeks before baseline, and had an HRSD-17 score of at least 18. Participants were randomly allocated (1:1) to treatment groups (10 Hz rTMS or iTBS) by use of a random permuted block method, with stratification by site and number […]

The CBS Evening News (6/7, story 3, 3:05, Glor) reported, “The CDC put out an alarming report today on suicide. Nearly 45,000 Americans took their lives in 2016. That is more than car accidents or opioid overdoses.” On ABC World News Tonight (6/7, story 7, 1:40, Muir), ABC News correspondent Gio Benitez said that “the CDC is reporting that suicide rates have increased by 25 percent over two decades.” NBC Nightly News (6/7, story 9, 0:30, Holt) reported that the CDC’s report “shows a dramatic rise in suicide rise in half the states across the US more than 30 percent from 1999 to 2016.” The New York Times (6/7, Carey, Subscription Publication) reports suicide rates increased in all states but Nevada between 1999 and 2016, according to a report from the Centers for Disease Control and Prevention. The report “found that slightly more than half of people who had” died by suicide “did not have any known mental health condition.” The Washington Post (6/7, Nutt) reports that Anne Schuchat, MD, the CDC’s principal deputy director, said, “The data are disturbing. The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.” Joshua Gordon, MD, PhD, the director of the National […]

TMS (Transcranial Magnetic Stimulation) is an FDA-cleared, non-invasive, non-drug therapy for patients with Major Depressive Disorders. In our practice we use a highly advanced MagVita TMS therapy system that possesses unique attributes relative to other available products. The market for TMS-based therapy has been growing, and the medical devices and accessories that are used to administer the therapy are being adapted and improved to provide greater patient comfort and more accurate and effective treatments. As noted in University of Florida research, TMS machines using arm attachments and coils that separate weight-bearing and positioning functions allows providers to administer therapy to patients in a variety of positions, with an attendant improvement in patient comfort and treatment accuracy. MagVita TMS therapy equipment uses flexible arms with four degrees of freedom, along with patient-focused designs for the chair and vacuum pillow. Choosing the Right TMS Equipment is Vital For providers, the selection of equipment is paramount. In our practice we use a MagVita therapy system, manufactured in Europe by a company dedicated to extremely high quality standards and integrating leading technology into its product offerings. MagVita machines and accessories provide a comparative market advantage in three key areas: Treatment chairs that adapt to […]

What is ASKP? The American Society of Ketamine Physicians is a group of professionals dedicated to the safe clinical use of ketamine for mental health disorders and pain conditions. The mission of the American Society of Ketamine Physicians to advocate for the safe and effective use of ketamine in the treatment of mental illness and pain disorder to promote high scientific, ethical, and professional standards among physicians providing ketamine therapy for mental illness and pain disorders to maximize quality of care by furthering knowledge, collaboration, and the exchange of ideas and research in the use of ketamine and other psychotropic medications for the treatment of mental illness and pain disorders. to expand access to ketamine therapy nationwide Basics of Administration All of the providers in our group ascribe to the same basic tenets of safety when administering Ketamine for Non-Anesthetic Indications (KNAI). 1. Patients should be screened for and have been found to have a condition that is appropriate for ketamine treatment – Unipolar Major Depression, Bipolar Depression, PTSD, OCD, Fibromyalgia, CRPS and chronic pain. 2. A full history and physical including psychiatric disorders and substance abuse disorders should be completed in the patient’s chart. 3. The patient’s medications and […]

by Elizabeth Hlavinka, MedPage Today InternJune 27, 2018 About 40% of patients with treatment-resistant major depression achieved remission in a randomized trial of repetitive transcranial magnetic stimulation (rTMS) — but the rate was virtually the same with sham treatment versus active stimulation, researchers said. Among 81 patients in Veterans Affairs medical centers assigned to active rTMS, 33 (40.7%) achieved remission at the end of treatment, compared with 31 of 83 (37.4%) receiving sham treatment, reported Jerome Yesavage, MD, of Stanford University School of Medicine, and colleagues in JAMA Psychiatry. After a 24-week follow-up phase, 16 out of the 81 receiving active treatment (19.8%) remained in remission while 13 (15.7%) of the sham did. “On the surface it’s puzzling why the active would not be better than the sham and why both groups showed such a high resistance rate,” Charles Nemeroff, MD, PhD, of the University of Miami, who wrote an editorial accompanying the study, told MedPage Today. Most other rTMS studies have shown benefit, though not always large, relative to control. “When patients are enrolled in clinical trials and they get a great deal of attention from healthcare providers,” Nemeroff said, “there’s a therapeutic effect that I think would explain to some extent the […]

June 12, 2018 Key Points Question How frequently do US adults use prescription medications with depression as a potential adverse effect and is use of these medications associated with concurrent depression? Findings In this cross-sectional US population-based survey study conducted between 2005 and 2014, the estimated overall prevalence of US adults using medications with depression as a potential adverse effect was 37.2%. The adjusted percentage of adults with concurrent depression was higher among those using more concurrent medications (eg, estimated 15% for ≥3 medications). Meaning Use of prescription medications that have depression as a potential adverse effect was common and associated with greater likelihood of concurrent depression. Abstract Importance Prescription medications are increasingly used among adults in the United States and many have a potential for causing depression. Objectives To characterize use of prescription medications with depression as a potential adverse effect and to assess associations between their use and concurrent depression. Design, Setting, and Participants Five 2-year cycles (2005-2006 through 2013-2014) of the National Health and Nutrition Examination Survey, representative cross-sectional surveys of US adults aged 18 years or older, were analyzed for use of medications with depression as a potential adverse effect. Multivariable logistic regression examined associations between use of these medications and concurrent depression. Analyses […]

Significance Identifying biological targets in major depressive disorder (MDD) is a critical step for development of effective mechanism-based medications. The epigenetic agent acetyl-L-carnitine (LAC) has rapid and enduring antidepressant-like effects in LAC-deficient rodents. Here, we found that LAC levels were decreased in patients with MDD versus age- and sex-matched healthy controls in two independent study centers. In subsequent exploratory analyses, the degree of LAC deficiency reflected both the severity and age of onset of MDD. Furthermore, the lowest LAC levels were found in patients with treatment-resistant depression, whereby history of emotional neglect and being female predicted decreased LAC levels. These translational findings suggest that LAC may serve as a candidate biomarker to help the diagnosis of a clinical endophenotype of MDD. Abstract The lack of biomarkers to identify target populations greatly limits the promise of precision medicine for major depressive disorder (MDD), a primary cause of ill health and disability. The endogenously produced molecule acetyl-L-carnitine (LAC) is critical for hippocampal function and several behavioral domains. In rodents with depressive-like traits, LAC levels are markedly decreased and signal abnormal hippocampal glutamatergic function and dendritic plasticity. LAC supplementation induces rapid and lasting antidepressant-like effects via epigenetic mechanisms of histone acetylation. This mechanistic […]

Mount Horeb, Wisconsin (CNN) By Ben Tinker and Dr. Sanjay Gupta, CNN Updated 8:36 AM ET, Sat August 4, 2018 A few months ago, Alan Ferguson decided he was ready to die — for the third time. In 2014, he attempted suicide twice, and the persistent thoughts of “I need to be dead” were echoing in his brain once again. Now 54 years old, Ferguson was diagnosed with clinical depression when he was 18. Since then, he estimates, he’s been prescribed more than a dozen medications — SSRIs, SNRIs, tricyclic antidepressants — all to little or no avail.” I never got to the point that I thought, ‘OK, I’m feeling good,’ ” he said. “It was always, ‘OK, this is tolerable.’ But yet those thoughts [of wanting to die] were still there.” In early May, Ferguson abruptly stopped taking all of his medications, quit his job and gave away his dog, Zeke. That evening, he called his sister, Linda.”It was a very good conversation,” he said. “Linda and I disagree on a lot of stuff, and that night I avoided the hot-button topics because I did not want her to have bad memories or bad thoughts of what I thought was going to […]

This Letter Shows that TBS is FDA Approved Tonica Elektronik A/S Sanne Jessen Medical Advisor Lucernemarken 15 Farum, 3520 Dk Re: K173620 Trade/Device Name: Mag Vita TMS Therapy System w/Theta Burst Stimulation Regulation Number: 21 CFR 882.5805 Regulation Name: Repetitive Transcranial Magnetic Stimulation System Regulatory Class: Class II Product Code: OBP Dated: July 10, 2018 Received: July 13, 2018 Dear Sanne Jessen: We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general […]

The US Food and Drug Administration (FDA) has approved a newer and faster treatment protocol for the MagVita repetitive transcranial magnetic stimulation (rTMS) therapy system from MagVenture, the company has announced. The FDA first cleared the MagVitaTMS therapy system in 2015 for treatment of adults with drug-resistant major depressive disorder, as reported by Medscape Medical News. Until now, each treatment session has lasted up to 37 minutes, with 20 to 30 sessions needed in total. With the new treatment protocol, which uses intermittent theta-burst stimulation (iTBS), a treatment session lasts only 3 minutes, the company said in a news release. The newly approved iTBS protocol is based on results of a multicenter, noninferiority clinical trial involving 414 adults with treatment-resistant major depression who were randomly allocated to receive standard rTMS or iTBS. The iTBS protocol was shown to be noninferior to rTMS, according to a report published in the Lancet earlier this year. For both treatments, the number of dropouts was low, and side-effect, safety, and tolerability profiles were similar. With iTBS, the number of patients treated per day with current rTMS devices can be increased several times without compromising clinical effectiveness, the authors concluded. “We have named it ‘Express TMS’ because that’s what it is: a treatment which is […]

August 2018: MagVenture’s Theta Burst solution is now FDA cleared. For people suffering from severe depression, the road to remission just became a lot shorter: The treatment is known as Transcranial Magnetic Stimulation (TMS), and MagVenture has now, as the only company in the US, received FDA clearance for a newer and much faster treatment protocol which will cut down treatment time to just 3 minutes per session*. Before that, the required treatment time per session was up to 37 minutes. TMS has been FDA cleared for treatment-resistant major depressive disorder since 2008. Since then, over 1,000 psychiatric clinics have emerged in the US. Most private health insurance companies also cover the treatment. The relatively long treatment sessions have, however, not only limited the treatment capacity for TMS practices but also hindered a more widespread dissemination. Until now, each session has been up to 37 minutes long, with 20-30 sessions needed in total. The new treatment form, which is known as Theta Burst Stimulation (TBS), offers one significant advantage: Time. A TBS treatment session lasts only 3 minutes and thus has the potential to revolutionize the clinical field of TMS. “We have named it “Express TMS®” because that’s what it […]

Glutamate neurotransmission is an active area of research in major depressive disorder (MDD).1 Much of this interest revolves around glutamate’s role in regulating synaptic connectivity, one of several pathways that may strengthen and initiate the formation of new synaptic connections.1 As research advances, a deeper understanding of MDD is within reach. Watch our video featuring Dr Samuel Wilkinson, Assistant Director at the Yale Depression Research Program, discussing the hypothesized roles of synaptic connections and glutamate signaling in MDD. Discovered as a neurotransmitter after serotonin and other monoamines, glutamate neurotransmission is an active area of research in MDD.1 Much of this interest revolves around glutamate’s role in regulating synaptic connectivity, one of several pathways that may strengthen and initiate the formation of new synaptic connections.1 HOW GLUTAMATE SIGNALING WORKS As part of a complex balancing act, glutamate signaling is tightly controlled by either inhibitory or excitatory proteins2 Once a burst of glutamate is released, the signal activates post-synaptic receptors3 These receptors then trigger downstream pathways that influence dendritic spine density, synaptic formation, and synaptic connectivity4 Glutamate signaling is one of several pathways that are being studied in MDD5 BDNF: Brain-derived neurotrophic factor Ca2+: Calcium ions TrkB: Tropomyosin-related kinase B Dendritic spines: Principal sites of synapses in […]

Impaired Synaptic Connections Research increasingly links impaired synaptic connections with MDD.1 Synaptic connections are constantly remodeled, created, and lost as a result of new experiences, emotions, learning, and memory.1 However, this synaptic plasticity may be impaired in patients with MDD.2 In a study published in Nature Medicine, researchers found a significantly lower number of synapses in key regions of post-mortem brains from patients who suffered from MDD compared to healthy subjects3 Preclinical studies show that chronic stress not only causes dendritic spines to atrophy and contract, but also reduces the number of synapses2,4 The impairment appears to be centered in the prefrontal cortex and hippocampus, which are areas of the brain involved in regulating mood and information processing5 Other brain regions that are affected include the amygdala, nucleus accumbens, and orbitofrontal cortex4 Structural and Functional Brain Changes are Associated with MDD The findings on synaptic impairment add to the evidence that MDD is associated with structural and functional abnormalities in the brain, as previously seen by neuroimaging studies. Again, the most consistent alterations are observed in the prefrontal cortex and hippocampus, where reduced gray matter volume is associated with more severe depression. Impaired synaptic plasticity within these and other brain regions may reduce the number […]

WHY AREN’T SOME PATIENTS WITH MDD REACHING REMISSION? For more than 50 years, major depressive disorder (MDD) pharmacological treatment approaches have focused on increasing the level of monoamine neurotransmitters in the brain, with the hope of reducing symptoms.1 And while conventional antidepressants have helped most, the STAR*D trial* found that one-third of patients didn’t achieve remission after multiple treatment attempts.2 What’s missing? BEYOND NEUROTRANSMITTERS: SYNAPTIC CONNECTIONS One emerging theory suggests that MDD may be linked to impaired synaptic connections in areas of the brain that regulate mood.3,4 The hypothesis points to an intriguing possibility: If synaptic connections are disrupted in MDD, can this synaptic impairment be improved?5 SYNAPTIC CONNECTIVITY: THE GLUTAMATE HYPOTHESIS Scientists are honing in on the role of glutamate, a major excitatory neurotransmitter that helps regulate synaptic connectivity.6 A burst of glutamate may initiate pathways that are believed to be involved in the strengthening and formation of new synaptic connections.5 As research advances, a deeper understanding of MDD is within reach. Watch THIS video or visit Janssen Pharmaceuticals Inc. to learn more.

NEW YORK (Reuters Health) – A 60-hour infusion of brexanolone significantly improves symptoms in women with postpartum depression, according to results from two phase 3 trials. The results “confirm and extend the previous work showing that brexanolone has a rapid onset of action that is unlike anything else currently available,” said Dr. Samantha Meltzer-Brody from the University of North Carolina at Chapel Hill School of Medicine. “Further, the robust treatment response to a single 60-hour infusion was maintained through the 30 days of follow-up in this clinical trial,” she told Reuters Health by email. Brexanolone is a proprietary, intravenous formulation of allopregnanolone, an endogenous progesterone metabolite that appears to modulate gamma-aminobutyric acid (GABA) receptors. Brexanolone showed rapid and durable antidepressant effects during an earlier phase 2 clinical trial. Dr. Meltzer-Brody and colleagues investigated the efficacy and safety of brexanolone injection in 246 women with moderate to severe postpartum depression in two randomized, placebo-controlled phase 3 trials at 30 U.S. centers. In study 1, Hamilton Rating Scale for Depression (HAM-D) total scores decreased to a significantly greater extent at the end of the 60-hour infusion in the group receiving brexanolone 60 mcg/kg per hour (mean reduction, 19.5 points) and in the […]

On September 26 2018 Scientific American published an article calling out some of the business practices being used by ketamine treatment providers across the country. The article summarized legitimate concerns about the business side of the ketamine while reiterating the promise ketamine shows as a breakthrough treatment for difficult to treat cases of depression. “This is not snake oil. It’s not something that has to be stamped out,” Lieberman said. “It’s something that has to be reined in.” PASWFL’s Approach to Ketamine Treatment Ketamine should be administered by a psychiatrist for the treatment of psychiatric disorders. At PASWFL, Ketamine is often part of a complete treatment plan that incorporates other treatments as well including transcranial magnetic stimulation, theta burst stimulation, and genomic testing. At PASWFL treatments are administered and overseen by a psychiatrist. We also use both the PHQ9 and the DSST evaluations throughout treatment to ensure patients are getting the care they need and are on a healthy trajectory towards healing. The First Antidepressant Was Discovered by Accident Ketamine is a new and still off-label treatment for depression. The development and improvement of medical treatments is an inherently iterative process.The National Institute of Health put together “A brief history […]

On April 25th 2018 the American Psychiatric Association published the following criticism of genomic testing emphasizing their skepticism towards psychiatrists who are using genetic testing to make informed decisions about diagnosis and treatment. An abstract of their statement reads: Evidence Does Not Support Commercial Rush Of DNA Tests Designed To Inform Decisions Regarding Patients’ Psychiatric Medications, Review Indicates. STAT (9/28, Robbins) reported that “several dozen companies” are now “probing patients’ DNA in search of insights to help inform decisions about what psychiatry medications patients should take,” and are even “touting applications for depression, bipolar disorder, attention deficit hyperactivity disorder, and post-traumatic stress disorder.” Now, “some top psychiatrists say the evidence doesn’t support the commercial rush.” In fact, in a review published online April 25 in the American Journal of Psychiatry, “a task force of the American Psychiatric Association’s research council concluded that such genetic testing is not ready for prime time in their field.” The members of the task force wrote, “Although some of the preliminary published data sound promising…there is insufficient evidence to support widespread use of combinatorial pharmacogenetic decision support tools at this point in time.” To read their full statement please visit this link. […]

Promise of Precision Medicine in Psychiatry Nears Reality BARCELONA, Spain — Innovative approaches and widespread data sharing are essential in psychiatry to improve patient care and deliver on the long-held promise of precision medicine, a leading European expert says. In a plenary lecture delivered here at the 31st European College of Neuropsychopharmacology (ECNP) Congress, Marion Leboyer, MD, PhD, professor of psychiatry, University of Paris-Est, Créteil, France, called for the creation of a virtual institute to leverage big data and build partnerships to speed the development of novel psychiatric treatments. She told a packed auditorium that much of the science needed to bring precision medicine to target different subgroups of patients is already in place, but that innovative, disruptive approaches are needed to bring that science to the clinic. Leboyer delivered the lecture as part of winning the 2018 ECNP Neuropsychopharmacology Award, which was given in recognition of her outstanding achievements in identifying genetic and environmental risk factors in major psychiatric disorders. The hope is that precision medicine in psychiatry will transform the diagnosis, treatment, and prognosis of patients with severe psychiatric disorders. “Today, bipolar disorders, depression, schizophrenia, autism spectrum disorders, OCD [obsessive compulsive disorder], and so many more are known […]

Key Points Question What are the trends across adulterated dietary supplements associated with a warning released by the US Food and Drug Administration from 2007 through 2016? Findings In this quality improvement study, analysis of the US Food and Drug Administration warnings from 2007 through 2016 showed that unapproved pharmaceutical ingredients were identified in 776 dietary supplements, and these products were commonly marketed for sexual enhancement, weight loss, or muscle building. The most common adulterants were sildenafil for sexual enhancement supplements, sibutramine for weight loss supplements, and synthetic steroids or steroid-like ingredients for muscle building supplements, with 157 products (20.2%) containing more than 1 unapproved ingredient. Meaning Potentially harmful active pharmaceuticals continue to be identified in over-the-counter dietary supplements. Abstract Importance Over half of adults in the United States report consuming dietary supplements. The US Food and Drug Administration (FDA) has warned of numerous dietary supplements containing undeclared, unapproved pharmaceutical ingredients. These FDA warnings have not been comprehensively analyzed for recent years. Objective To summarize trends across adulterated (containing unapproved ingredients) dietary supplements associated with a warning released by the FDA from 2007 through 2016. Design, Setting, and Participants In this quality improvement study, data were extracted from the FDA’s Center for Drug Evaluation and Research, […]

For people suffering from severe depression, the road to remission just became a lot shorter: The treatment is known as Transcranial Magnetic Stimulation (TMS), and MagVenture has now, as the only TMS provider in the US, received FDA clearance for a newer and much faster treatment protocol which will cut down treatment time to just 3 minutes per session*. Before that, the required treatment time per session was up to 37 minutes. TMS has been FDA cleared for treatment-resistant major depressive disorder since 2008. Since then, over 1,000 psychiatric clinics have emerged in the US. Most private health insurance companies also cover the treatment. The relatively long treatment sessions have, however, not only limited the treatment capacity for TMS practices but also hindered a more widespread dissemination. Until now, each session has been up to 37 minutes long, with 20-30 sessions needed in total. The new treatment form, which is known as Theta Burst Stimulation (TBS), offers one significant advantage: Time. A TBS treatment session lasts only 3 minutes and thus has the potential to revolutionize the clinical field of TMS. “We have named it “Express TMS®” because that’s what it is: a treatment which is just as safe and […]

For 50 years, pharmacological treatment approaches in MDD have focused on targeting monoamine receptors in the hopes of reducing symptoms. While conventional therapies have helped many, the STAR*D trial* revealed that as many as a third of patients may not achieve remission despite treatment with traditional antidepressants.¹,² Dr Rakesh Jain, clinical professor of psychiatry at Texas Tech University School of Medicine, discusses the estimated 5 million patients who aren’t reaching remission despite multiple treatment attempts in a video available on ConnectingMDD.com. THE LIKELIHOOD OF REMISSION DROPS TO 14% AFTER A SECOND TREATMENT FAILURE* In the STAR*D trial, 37% of patients reached remission after the first-line treatment step with an oral antidepressant.1 The chances for remission dropped substantially after 2 treatment attempts, even with augmentation strategies.1 WITHOUT REMISSION, THE BURDEN OF MDD GROWS REFERENCES Rush AJ, et al. Am J Psychiatry. 2006;163:1905-1917. The National Institute of Mental Health. Major depression among adults. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Updated November 2017. Accessed April 6, 2018. Uher R, et al. Depress Anxiety. 2014;(31):459-471. Feldman RL, et al. J Med Econ. 2013;16(1):62-74.

Reason for Treatment: depression and anxiety for 5-6 years. Started with panic attacks and anxiety. outside stressors developed depression that escalated over time. panic attacks under control with proper medication. depression hit it’s worst state in the middle of 2018. I was ready to quit on everything. I was not suicidal or interested in losing my life, but I had lost my love and interest for the things that normally inspire me. I was no longer inspired by my work, my faith, or the people around me. I was spending days at a time in bed, delaying inevitable problems because staying in bed was easier than facing stressors. I let this carry on far too long because I had reservations about TBS. After several meetings with Dr Pollack I committed to TBS. below are my daily observations both physical and mental. Day 1: very reserved, inquisitive, a little nervous. learned about the machine, Nora told me what it did physically and how it would affect me. What i should expect to feel. Expectations set were far too severe. I was told to expect discomfort and a slight pain, having tattoos and piercings this sensation was a walk in the park. […]

By Alan Mozes HealthDay Reporter THURSDAY, Dec. 27, 2018 (HealthDay News) — Teens who are often bullied may be left with shrinkage in key parts of their brain, increasing their risk for mental illness, European researchers report. They said such shrinkage eventually appears to create a growing sense of anxiety, even after taking into account the possible onset of other mental health concerns, such as stress and/or depression. “We don’t know how early in life these brain changes begin,” said study author Erin Burke Quinlan. “But the earlier bullying is identified, and the sooner it can be dealt with, the better.” Her team analyzed brain scans of nearly 700 14- to 19-year-olds in England, Ireland, France and Germany. The teens were part of a long-term project called IMAGEN that is studying adolescent brain development and mental health. “We found that the relationship between chronic peer victimization — an umbrella term that includes bullying — relates to the development of anxiety partly via changes in the volume of brain structures,” Quinlan said. She’s an IMAGEN project coordinator at the Center for Population Neuroscience and Precision Medicine at King’s College London. Researchers aren’t sure if the bullied teens’ brain shrinkage is permanent […]

Patients with anxious depression—major depressive disorder (MDD) with high levels of anxiety—are known to have a poorer response to commonly used antidepressants than those with MDD. A small study published in Depression & Anxiety now suggests intravenous (IV) ketamine may be able to reduce symptoms in patients with anxious depression. The study found patients with and without anxious depression experienced similar symptom improvements within 24 hours of receiving a ketamine infusion. Naji C. Salloum, M.D., of Harvard Medical School and colleagues compared the effectiveness of IV ketamine to that of midazolam (preoperative sedative) in relieving symptoms of depression with anxiety. They randomized 99 patients with treatment-resistant depression to one of five arms: a single dose of IV ketamine (0.1 mg/kg, 0.2 mg/kg, 0.5 mg/kg, or 1.0 mg/kg) or midazolam (0.045 mg/kg). Forty-five of those patients had anxious depression as defined by a Hamilton Depression Rating Scale Anxiety/Somatization score of at least 7. Using several depression scales, the researchers evaluated the patients’ symptoms on the first and third days after treatment. Although all patients responded to their treatment (either ketamine or midazolam), those who had received ketamine experienced greater improvements in their symptoms. Furthermore, there were no significant differences in response between the anxious and […]

By Paul Croarkin, DO, Research Committee Co-chair and Philip Janicak, MD, Research Committee Member Introduction Perinatal depressions are serious, debilitating conditions which are often under-recognized; and, even when properly diagnosed, often sub-optimally treated. Notably, they can contribute to problematic maternal behaviors such as substance use, poor self-care, non-adherence to prenatal care, and a heightened risk for suicide. Maternal outcomes and the pathophysiology of untreated depression create challenges from conception throughout development via epigenetic mechanisms, aberrations in fetal brain development, and mother-child bonding. For example, offspring of depressed mothers are at an increased risk for future psychiatric disorders and related functional impairment.1,2 Standard treatment approaches of perinatal depression include evidence-based psychotherapies such as cognitive behavioral therapy (CBT) or interpersonal psychotherapy (IPT). Selective serotonin re uptake inhibitors (SSRIs) are the mainstay pharmacologic approach, often used in conjunction with psychotherapy. Studies consistently demonstrate that many mothers’ are hesitant about taking antidepressants while pregnant or nursing.2 As a result, both researchers and clinicians have considered the potential role for noninvasive brain stimulation modalities such as repetitive transcranial magnetic stimulation (TMS), as an alternative and possibly safer intervention for perinatal depressions. TMS is an appealing option given the lack of systemic effects that are typically associated […]

Abstract Postpartum depression (PPD) affects over 10% of new mothers and adversely impacts the health of offspring. One of the greatest risk factors for PPD is prepregnancy stress but the underlying biological mechanism is unknown. Here we constructed an animal model which recapitulated prepregnancy stress induced PPD and tested the role of Akt-mTOR signaling in the hippocampus. Female virgin Balb/c mice received chronic restraint stress, followed by co-housing with a normal male mouse. We found that the chronic stress led to a transient depressive-like condition that disappeared within two weeks. However, prepregnantly stressed females developed long-term postpartum depressive-like (PPD-like) symptoms as indicated by deficient performance in tests of sucrose preference, forced swim, and novelty-suppressed feeding. Chronic stress induced transient decrease in Akt-mTOR signaling and altered expressions of glutamate receptor subunits NR1 and GluR1, in contrast to long-term deficits in Akt-mTOR signaling, GluR1/NR1 ratio, and hippocampal neurogenesis in PPD-like mice. Acute ketamine improved the molecular signaling abnormality, and reversed the behavioral deficits in PPD-like mice in a rapid and persistent manner, in contrast to ineffectiveness by chronic fluoxetine treatment. Taken together, we find that chronic prepregnancy stress potentiates a long-term PPD, in which Akt-mTOR signaling may play a crucial role. Introduction […]

Abrupt discontinuation of an antidepressant was found to be the most likely cause of brain zaps A recently published article discusses the characteristics, symptoms, and effects on quality of life associated with brain zaps, the electrical phenomenon that can occur following antidepressant discontinuation. The study authors explained, “In some patients, stopping or reducing the dose of an antidepressant can lead to electrical sensations (or brain zaps) perceived as occurring inside the brain.” To gain more insight into this poorly understood symptom of antidepressant discontinuation, the study authors analyzed 595 unso licited posts discussing brain zaps on a mental health website, Mental Health Daily, between December 13, 2014, and December 12, 2016. Further analysis and separation of the posts yielded a total of 648 statements discussing antidepressant intake; 378 of these statements discussed symptoms experienced following the discontinuation of an antidepressant. “These posts were further analyzed for specifics of the medications involved, temporal characteristics of the medication intake, associated symptoms, specifics of the “zap” experience itself, and effect of the zaps on quality of life,” the study authors added. Compared with how often the antidepressant was prescribed in clinical practice, brain zaps were reported more frequently with venlafaxine and paroxetine and less so with fluoxetine. “This finding mirrors […]

Joe Wright has no doubt that ketamine saved his life. A 34-year-old high school teacher who writes poetry every day on a typewriter, Wright was plagued by suicidal impulses for years. The thoughts started coming on when he was a high schooler himself, on Staten Island, N.Y., and intensified during his first year of college. “It was an internal monologue, emphatic on how pointless it is to exist,” he says. “It’s like being ambushed by your own brain. He first tried to kill himself by swallowing a bottle of sleeping pills the summer after his sophomore year. Years of treatment with Prozac, Zoloft, Wellbutrin, and other antidepressants followed, but the desire for an end was never fully resolved. He started cutting himself on his arms and legs with a pencil-sharpener blade. Sometimes he’d burn himself with cigarettes. He remembers few details about his second and third suicide attempts. They were halfhearted; he drank himself into a stupor and once added Xanax into the mix. Wright decided to try again in 2016, this time using a cocktail of drugs he’d ground into a powder. As he tells the story now, he was preparing to mix the powder into water and drink […]

(HealthDay News) — Esketamine seems to be efficacious and safe for patients with treatment-resistant depression (TRD), according to a study published online Dec. 27 in JAMA Psychiatry. Ella J. Daley, M.D., from Janssen Research & Development LLC in Titusville, N.J., and colleagues conducted a phase 2, double-blind, doubly randomized, delayed-start, placebo-controlled study to examine the efficacy, safety, and dose-response of intranasal esketamine hydrochloride. A total of 67 adults with a diagnosis of major depressive disorder and history of inadequate response to two or more antidepressants (TRD) were randomized and 60 completed two one-week double-blind treatment periods. In period 1, participants were randomized to placebo or esketamine 28, 56, or 84 mg twice weekly (33, 11, 11, and 12 participants, respectively). In period 2, 28 placebo-treated participants were re-randomized to one of the four treatment arms. The researchers found that the change in Montgomery-Åsberg Depression Rating Scale total score was superior in all three esketamine groups versus placebo (least squares mean difference versus placebo: esketamine 28 mg: −4.2; 56 mg: −6.3; 84 mg: −9.0), with a significant ascending dose-response relationship. Despite reduced dosing frequency in the open-label phase, the improvement in depressive symptoms appeared to be sustained (−7.2). “In this first clinical […]

Janssen announced new findings from a Phase 2 study evaluating esketamine nasal spray in patients with major depressive disorder who were at imminent risk for suicide. The findings were published in the American Journal of Psychiatry. Esketamine nasal spray is an investigational glutamate receptor modulator that is thought to help restore synpatic connections in brain cells in patients with major depressive disorder. The double-blind, multicenter, proof-of-concept study randomized 68 patients to either esketamine nasal spray 84mg or placebo twice weekly for 4 weeks in addition to standard of care treatment. The primary efficacy endpoint was change from baseline to 4 hours post-dose on Day 1 in the Montgomery-Asberg Depression Rating Scale (MADRS) total score; clinician global judgment of suicide risk (based on the Suicide Ideation and Behavior Assessment Tool) was also assessed. Treatment with esketamine led to a statistically significant, clinically meaningful improvement in depressive symptoms at 4 hours, including a measure of suicidal ideation in study patients, compared to placebo. Results showed that compared with placebo, treatment with esketamine led to a significantly greater improvement in MADRS total score 4 hours after the first dose (-13.4 for esketamine nasal spray + standard of care vs -9.1 for placebo nasal spray + standard of […]

The Food and Drug Administration (FDA)’s Psychopharmacologic Drug Advisory Committee and Drug Safety and Risk Management Advisory Committee voted in favor (14 yes, 2 no, 1 abstain) of the approval of esketamine nasal spray (Spravato; Janssen) for the treatment of adult patients with treatment-resistant depression (TRD). The decision was based on data from five Phase 3 studies assessing the safety and efficacy of esketamine, a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist; patients in these studies had a history of inadequate response to least 2 prior antidepressants and generally had more severe symptoms than those who participated in antidepressant studies for previously approved drugs. Results from 2 of these Phase 3 studies (1 short-term, 1 long-term), which primarily provided the evidence to support effectiveness, showed that treatment with esketamine nasal spray plus a newly initiated oral antidepressant was associated with a statistically significant, clinically meaningful, rapid, and sustained improvement of depressive symptoms vs placebo nasal spray plus a newly initiated oral antidepressant. With regard to safety, the adverse events identified as those of greatest concern were sedation, dissociation, and blood pressure increases, most of which occurred within the first 2 hours of administration. To address these issues, the committees proposed a Risk […]

Each disposable intranasal delivery device contains 28 mg esketamine; it will come in prepackaged units of one, two, or three devices to deliver the prescribed doses of 28 mg, 56 mg, or 84 mg, respectively. The device does not require priming and, after use, contains only about 30 microliters of residual medication. Its interlocking design, with a glass vial inside the plastic outer assembly, would make it very difficult to pull apart, should anyone want to obtain the residue. The proposed REMS – the key requirement for approval at this point – would include the following measures: Prescriber training on the risks of esketamine and importance of monitoring patients after their dose is administered and the need to register patientsAdministration of esketamine only in certain health care settings that ensure patient monitoring by a health care clinician for 2 hours after administrationPharmacies, clinicians, or health care settings that dispense the drug are specially certified to ensure that esketamine is not dispensed directly to patients and that patients are monitoredEnrollment of patients who are treated with esketamine in a registry to better characterize the risks associated with esketamine administration and inform risk mitigation strategies After administration, patients would be monitored for […]

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